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    Diabetes and pregnancy

    What is gestational diabetes?

    It’s a high sugar level in the blood, occurring only during pregnancy. For most women (90%), this condition disappears after the baby is born.

    How does it happen?

    The insulin is a hormone that is secreted by the pancreas that permits the sugar (glucose) to enter our body cells to give us energy. 
    During pregnancy, the placenta produces hormones that stop the insulin action. For certain women this can cause sugar storage in the blood (mostly at the end of the second or third trimester). This is known as hyperglycemia.

    Generally, a pregnant woman does not notice it, but sometimes it may cause unusual fatigue, exaggerated thirst or even urinating in bigger quantities (not only more frequently).

    Why me?

    Certain factors increase the risk of getting gestational diabetes:

    . Being older than 35 years old

    . Family history

    . Obesity (if your weight is over 20% or more of your healthy weight)

    . Having been diagnosed with gestational diabetes before

    . Having had a baby weighing more than 9 pounds (4 kg).

    Even if you do not have any of these factors or a few of them, you still can suffer from gestational diabetes.

    How can we diagnose gestational diabetes?

    When women get pregnant they all get blood work done. One of the blood test is for blood glucose (sugar level in the blood) at random, meaning at anytime during the day. In rare cases, the results are not normal and your doctor will rapidly order other tests so he can verify the presence of diabetes.

    In most cases, the diagnostic is made between the 22sd and 26th week of pregnancy. All pregnant women get tested for diabetes. They have to drink a very sweet liquid containing 50 grams of glucose and they will take a test an hour later.

    Women that once had gestational diabetes will be required by their doctor to take an oral hyperglycemia test at their first trimester.

    If your sugar level is not under control t
    he following complications may occur:

    For the mother: 

    -
    Increased fatigue

    -
    Higher risk of infection (bladder, kidney, particularly vagina)

    -
    Polyhydramnios: excess amniotic fluid that can provoke a premature birth

    -
    Higher risk of a C-section.

    For the foetus:

    First of all you have to know that gestational diabetes does not increase the risks of having a child with malformation.

    -
    Macrosomia: birth of a baby bigger than usual with the difficulties that can be brought on at birth (why C-sections are done more frequently).

    -
    Hypoglycemia of the newborn: at birth, the baby does not get any more sugar from the mother. Since his pancreas is used to producing more insulin than normally, in reaction to the excess of sugar that his mother was giving him, the sugar level of the new born is at risk of diminishing.

    -Other problems: jaundice, especially on premature babies, hypocalcemia (lack of calcium in the blood) and certain respiratory problems.

    All of these complications occur when the gestational diabetes is not under control. The following advice is to try to prevent any complications:

    Treatment and control

    During the pregnancy, what should I do to control my diabetes?

    The most important thing is to follow your no concentrated sugar food guide. It is not about losing weight. You will have to consult a nutritionist or dietician who will explain what it consists of.

    A well balanced diet, exercise, sleep and rest will be enough for some women to control their gestational diabetes. For others, insulin will have to be added.

    To make sure that your blood glucose is well controlled, a nurse will ask you to regularly verify it with a monitor.Normal blood glucose levels for a pregnant woman are:

    -3.3 to 5.2 mmol/l fasting

    -3.8 to 7.7 mmol/l one hour after a meal

    -3.8 to 6.6 mmol/l two hours after a meal

    If those rates are abnormally high even by following your food guide, you will need insulin. The nurse will teach you how to prepare, inject and adjust the insulin dosage vs the obtained results.

    What will be the follow-up during my pregnancy?

    You will have the same tests as any other mother. On top of your regular visits (average of 1 to 3 times per month), you will have to meet with doctors, nurses and dietician or nutritionist at the endocrinology clinic. For the other tests, they will depend on how the pregnancy evolves.

    And childbirth?

    As soon as the regular contractions begin, you will have to cease your insulin (if you are taking some). During labor, they will monitor your blood glucose (it will tend to lower, because labor takes up a lot of energy). They will put you on a serum solution containing dextrose (sugar) and if necessary, insulin.

    As for the baby, they will check his blood glucose on a regular basis, during the hours following his birth. If necessary they will give him an intravenous sugar serum.

    Food

    The food quality of a pregnant woman has a big impact on the mother and child’s health. A well balanced diet will give the foetus a good growth, help build up maternal supplies and a good preparation for breastfeeding.

    With gestational diabetes, some modifications will be needed food wise. Food is the basic element to diabetes treatment.
    The food guide that you will be offered will have to contain quantity and quality for your needed nutritional value, while insuring a good blood glucose control. It will be personalized, because each pregnant woman is different. Unless you are a dietician, you must not try to modify your diet plan on your own.

    The recommended weight gain for a diabetic pregnant woman is the same as for a non diabetic pregnant woman:

    1 to 2kg (2 to 4 pounds) during the first trimester and 0,35 to 0,45kg (3/4 to 1 pound) per week for the second and third trimester. This gain has to be on a regular basis. For most women, a gain between 11 to 14kg (24 to 30 pounds) is sufficient.

    After pregnancy:

    Will my child be diabetic at birth?


    No, unless pure fate.

    Will I be able to breastfeed?

    We strongly recommend it since it brings on main advantages for you and your baby. Keep on with the diet (quantity-quality) that you had during your pregnancy.

    Will I be diabetic after the birth of my child?

    As we mentioned before, for 90% of women, the blood glucose returns to normal after childbirth and often the same day.
    You will be asked to have an oral hyperglycemia test containing 75g of glucose around 6 weeks after childbirth or after breastfeeding, to check if your glucose tolerance is back to normal.

    But take note that with the passing years, the risks of becoming diabetic will increase, especially if you keep excess weight on.

    For this reason after childbirth we advise you to:

    -
    Check your weight, keep a well balanced diet and exercise 3 times per week.

    -
    Get a provoked hyperglycemia test every 12 to 24 months.

    -
    Consult your doctor before becoming pregnant again.Knowing that diabetes can increase your chances of heart diseases in the long term, we recommend to quit smoking right away and to get regular check-ups if you suffer from high blood pressure.